<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Approve_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-approve_id" data-rule="required" data-source="approve/index" class="form-control selectpage" name="row[approve_id]" type="text" value="{$row.approve_id|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Examine_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-examine_id" data-rule="required" data-source="examine/index" class="form-control selectpage" name="row[examine_id]" type="text" value="{$row.examine_id|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Examine_result')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-examine_result" class="form-control" name="row[examine_result]" type="text" value="{$row.examine_result|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Examine_refuse')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-examine_refuse" class="form-control" name="row[examine_refuse]" type="text" value="{$row.examine_refuse|htmlentities}">
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
        </div>
    </div>
</form>
